On 8 January, we hosted a webinar about the needs and challenges of electronic prescribing and medicine administration (ePMA) in mental health trusts in the UK.
The topic was presented by Christine Wadsworth, a clinical pharmacist with more than 25 years of experience in clinical practice and ePMA implementation. She is currently ePMA Implementation Lead at the healthcare software company Advanced – one of Marand’s partners for OPENeP (Marand’s ePMA system) implementation in the UK.
Christine’s short presentation was followed by a discussion with our OPENeP Business Developer and Communications Manager Tjaša Zajc, and a Q&A with the online audience. You can find the questions from the Q&A session at the bottom of this post, supplemented with answers from Christine and OPENeP Product Manager Roko Malkoč.
What is specific in mental health trusts?
The first challenge in a mental health setting mentioned by Christine Wadsworth at the beginning of her presentation, is the environment: “In my 6 year practice with ePMA implementation we realized very soon that service users (patients) in mental health settings are suspicious of any changes, especially when people suddenly show up with laptops, or if a nurse visits them at home and taps away on a tablet or phone.”
Before software implementation, it is key for the institution to assemble a group of representatives of all the care settings, because they may have different requirements from an ePMA system in order to perform their role. In the mental health setting, care is delivered in a hospital, in a community clinic or at a patient’s home.
A challenge for an ePMA provider is:
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Register for a free webinar ”Free webinar: Mental health trusts: what should electronic medication management systems support?” recording with Christine Wadsworth a clinical pharmacist with more than 25 years of experience in clinical practice and ePMA implementation and Tjaša Zajc, OPENeP Business Developer and Communications Manager. |
Some important points before ePMA implementation are:
In practice, the implementation takes at least seven to nine months. Before going live, the provider needs to know which ward will be the pilot site, prepare a GAP analysis of the current processes, and consider how to achieve the best possible adoption. Going from paper to a computer system can be especially difficult for infrequent computer users, making training plans and learning resources preparation a vital part of the implementation.
What mental health trusts considering an ePMA implementation should ask ePMA providers:
In the end, with a successful implementation of an ePMA system, the users are often surprised by various benefits an ePMA system provides – a constant availability of medication information, a clear audit trail and reports of processes, which can contribute to care optimisation.
- How easy is ePMA to deploy in primary care? Do you have any experience with transmural implementations? In the Netherlands, the Dutch government is pushing towards transmural implementations of critical healthcare processes.
Christine Wadsworth: It is more difficult to deploy ePMA into primary care (community) settings than in the inpatient setting. This is due to the number of health care professionals involved, their lack of access to computer systems with all the information they need, and the use of mobile devices which may not have the ability to provide all the information required.
I have experience of the use of ePMA in the ePMA Community setting where patients had transferred from secondary care (i.e. transmural), which had been done successfully but was still problematic even after the go-live due to the limitations of the ePMA system used. With the right ePMA system and the correct access and planning, the transmural implementation would be less problematic.
- Does the OPENeP system generate FP10HP prescriptions? Does it require the prescriber to add an indication?
Roko Malkoč, OPENeP Product Manager: At the moment, generation of FP10HP prescriptions requires some more work, which is currently in progress. OPENeP does allow the entry of an indication, which is mandatory for some medications, e.g. ‘when required’ or PRN prescriptions, antibiotics, critical drugs...
- Are there any specifics when it comes to children and drugs administration for them? If a legal custodian is assigned to the patient, how would that be managed in real-life situations?
Roko M.: OPENeP was developed at the University Children's Hospital Ljubljana, in collaboration with doctors, pharmacists, and nurses. The system enabled dose calculation based on the patient weight and body surface, the use of unlicensed drugs, doses and routes, which are highlighted within the system. There is decision support for age, and also witnessing of administrations within locations, as well as for specific routes and controlled drugs.
If the legal custodian is administering drugs instead of the nurse, the system will allow this with the ‘patient declared administration’ setting which can be automatically charted. If the policy requires nurse confirmation for the administration, the ‘nurse charted’ setting can be used. Each administration has a comment box for the nurse to document any relevant information.
- Are all the requirements and questions concerning the requirements mentioned (one example: how does the system handle administrations/doses when a patient is on leave), are these written down somewhere and possible to get hold of?
Christine W.: Ann Slee from NHS England can assist with the requirements to assist Mental Health Trusts with their selection of an ePMA system.
- How important is the graphic design of the system?
Christine W.: It is very important that the system shows usability, and the design is a large part of this. If the screens are too full of content, the user will be bombarded with information and might miss a key piece of information.
Prescriptions should be clear with clear dose and frequency displays, and the electronic drug chart should be simplistic so that errors cannot be made when selecting doses.
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